India Application for Sikshashree Scholarship to SCST Student free printable template

Government of West Bengal Backward Classes Welfare Department APPLICATION FOR SIKSHASHREE SCHOLARSHIP TO SC / ST STUDENT STUDYING IN CLASS V TO VIII NEW/ RENEWAL Entitlement Card No. Full Name of Applicant In BLOCK Letter Shri / Kumari. Name of Father/Mother/Guardian. Sex M F 4. Date of Birth. / /. 5. Tele No* if any. a Caste SC / ST b Sub-Caste. Permanent Address House No*/ Village/ Para/ Road One Passport size Photo with selfsignature thereon duly attested to be pasted here and other two...without attestation are to be submitted Post Office Police Station District Particulars regarding Father / Mother / Guardian who supports in applicant s studies a Name b Occupation if employed give income c Address certificate from the Employer Bank Details Bank Name State Branch Name Name and Address of Institution Institution Name S*B. Account Number Class of Study IFSC Code MICR Actual Date of Joining the Class Whether you in receipt of this Scholarship in the previous year YES / NO if YES...Amount Received Scholarship Name Give Details Rs. Whether applied for any other Stipend / Scholarship. Annual Gross Family Income from all sources I undertake that all the statements given above are correct and I have not applied for any scholarship from any other Department. I shall be liable to penal action if any statement made above is found false / incorrect. Date Place Signature of the Father/Mother/Guardian Page 1 of 2 The statements made by the applicant at Serial No* 1...to 13 are correct to the best of my knowledge. Signature of Head of Institution Name in BLOCK Letter. Designation. State. Pin Code. SEAL INCOME CASTE AND RESIDENTIAL CERTIFICATE Should be signed either by a Member of Parliament or Member of a State Legislature or a Municipal Commissioner / Councilor / Panchayat Prodhan / Member of Zilla Parishad / Savapati of Panchayat Samity or a Government Officer. The Issuing Authority is requested to observe due caution as Scholarship is awarded on the basis...of this very important document. In case of 9 b Income Certificate of Employer is sufficient. Certified that the information furnished point nos. 1 to 13 overleaf are correct to the best of my knowledge. Pin Code. This certificate will not be considered as a conclusive proof in case of issuance of Caste Certificate by competent authority. Note 1. This form need not necessarily be obtained from Block / PO office and can be used by copying or downloading from the official website of the BCW...Department www. anagrasarkalyan*gov*in / www. bcwdwb. gov*in 2. Attested copies of all documents in support of claims for scholarship to be furnished along with this application* Original documents will be required to be produced for verification at the time of submission* 3. Payment of scholarship will be made only through Bank Account. 4. All column are to be filled up* No column should be left blank. Name of Father/Mother/Guardian. Sex M F 4. Date of Birth. / /. 5. Tele No* if any. a Caste...SC / ST b Sub-Caste. Permanent Address House No*/ Village/ Para/ Road One Passport size Photo with selfsignature thereon duly attested to be pasted here and other two without attestation are to be submitted Post Office Police Station District Particulars regarding Father / Mother / Guardian who supports in applicant s studies a Name b Occupation if employed give income c Address certificate from the Employer Bank Details Bank Name State Branch Name Name and Address of Institution Institution...Name S*B.